Treatment is identical for withdrawal from all sedative-hypnotics, including barbiturates, sleeping pills, benzodiazepines, and alcohol, because all drugs in these categories exhibit cross-dependence. The first step is to objectively determine an approximate level of drug to which the patient is tolerant since patients overestimate or underestimate the amount of drug they have been taking. While, as with opioids, precise instruments for the measurement of tolerance exist, they require nursing or medical staff with sophisticated knowledge of the intoxication and withdrawal symptoms and are time-intensive to administer.21,22 Thus, these precise methods are not practical for use in an emergency department or general practitioner's office. Fortunately, in many cases, it is not necessary to be so precise. Observation in an 8-hour partial hospitalization unit is often sufficient. While any drug causing cross-dependence can be used, a scheme for using phenobarbital follows: an initial dose is given, usually 60 to 90 mg of phenobarbital (Table 6), and the patient is monitored for at least 6 to 8 hours. The withdrawal drug can be repeated hourly or at 2-hour intervals, as indicated by the signs of withdrawal the patient is exhibiting. After 8 hours, an approximation can be made of the total dose the patient will require for a 24-hour period. Again, it is better to err on the side of slightly overmedicating than undermedicating. The dose is tapered starting from that dose. Reducing the dose by 10% of the initial dose each day provides a comfortable taper, especially if the patient is expected to participate in demanding psychological therapy exercises or if the patient has coexisting medical conditions. The taper can be accomplished much more rapidly if these conditions do not exist. The use of a long-acting barbiturate decreases the severity of withdrawal symptoms, and phenobarbital is chosen in preference to other sedatives because it has a longer half-life than diazepam, patients rarely achieve a "high" from phenobarbital as they do from the other drugs, and it is available in multiple dosage forms. The dose of phenobarbital can be given in a constant volume of liquid for each dose so the patient is not aware of the amount being decreased each day ("blind taper"), if this is desirable.